Sinus Disease
Have you ever had a cold or allergy attack that would not go away? If so, there is a good chance you actually had sinusitis. Experts estimate that 37 million people are afflicted with sinusitis each year, making it one of the most common health conditions in America. That number may be significantly higher, since the symptoms of bacterial sinusitis often mimic those of colds and allergies, and many sufferers never see a doctor for proper diagnosis and treatment.
Acute bacterial sinusitis is an infection of the sinus cavities caused by bacteria. It usually is preceded by a cold, allergy attack, or irritation by environmental pollutants. Unlike a cold, or allergy, bacterial sinusitis requires treatment with an antibiotic to cure the infection and prevent future complications.
Normally, mucus collecting in the sinuses drains into the nasal passages. When you have a cold or allergy attack, your sinuses become inflamed and are unable to drain. This can lead to congestion and infection. Your doctor will diagnose acute sinusitis if you have up to 4 weeks of purulent nasal drainage (thick, colored discharge), nasal obstruction, facial pain/pressure/fullness, or a combination of these symptoms.
When does acute sinusitis become chronic?
When you have frequent sinusitis, or the infection lasts three months or more, it could be chronic sinusitis. Symptoms of chronic sinusitis may be less severe than those of acute; however, untreated chronic sinusitis can cause damage to the sinuses that sometimes requires surgery to repair.
Treatment options
Antibiotic therapy — Therapy for bacterial sinusitis should include an appropriate antibiotic. If you have three or more symptoms of sinusitis, be sure to see your doctor for diagnosis. An oral or nasal spray or drop decongestant may be recommended to relieve congestion, although you should avoid using over-the-counter nasal sprays for more than a few days.
Antibiotic resistance means that some infection-causing bacteria are immune to the effects of certain antibiotics prescribed by your doctor. Antibiotic resistance is making even common infections, such as sinusitis, challenging to treat. You can help prevent antibiotic resistance. One way is to wait until your doctor confirms a bacterial infection before starting antibiotics.
Intensive antibiotic therapy — If your doctor thinks you have chronic sinusitis, intensive antibiotic therapy may be prescribed. Surgery is sometimes necessary to remove physical obstructions that may contribute to sinusitis.
Sinus surgery — Surgery should be considered only if medical treatment fails or if there is a nasal obstruction that cannot be corrected with medications. The type of surgery is chosen to best suit the patient and the disease.
Functional endoscopic sinus surgery (FESS) is recommended for certain types of sinus disease. With the endoscope, the surgeon can look directly into the nose, while at the same time, removing diseased tissue and polyps and clearing the narrow channels between the sinuses. The decision whether to use local or general anesthesia will be made between you and your doctor, depending on individual circumstances.
Before surgery, be sure that you have realistic expectations for the results, recovery, and postoperative care. Good results require not only good surgical techniques, but a cooperative effort between the patient and physician throughout the healing process. It is equally important for patients to follow post-operative instructions to ensure the best result.
Can children suffer from sinus infections?
A child’s sinuses are not fully developed until age 20. However, children can still suffer from sinus infection. Although small, the maxillary (behind the cheek) and ethmoid (between the eyes) sinuses are present at birth. Sinusitis is difficult to diagnose in children because respiratory infections are more frequent and the symptoms can be subtle.
The following symptoms may indicate a sinus infection in your child:
- A "cold" lasting more than 10 to 14 days, sometimes with low-grade fever.
- Post-nasal drip, sometimes leading to or exhibited as sore throat, cough, bad breath, nausea and/or vomiting.
- Headache, usually in children age six or older.
- Irritability or fatigue.
- Swelling around the eyes.
If these symptoms persist despite appropriate medical therapy, care should be taken to seek an underlying cause. The role of allergy and frequent upper respiratory infections should be considered.
Prevention
As always, an ounce of prevention is worth a pound of cure. To avoid developing sinusitis during a cold or allergy attack, keep your sinuses clear by:
- Blowing your nose frequently, blocking one nostril while blowing through the other.
- Drinking plenty of fluids to keep nasal discharge thin.
- Avoiding air travel — and if you must fly, using a nasal spray decongestant before descending to prevent blockage of the sinuses, allowing mucus to drain.
- If you have allergies, avoiding contact with things that trigger attacks. If you cannot, use over-the-counter or prescription antihistamines and/or a prescription nasal spray to control allergy attacks.
- Allergy testing, followed by appropriate allergy treatments, may increase your tolerance of allergy-causing substances.
For more information, see the American Academy of Otolaryngology — Head and Neck Surgery patient resources at https://www.entnet.org/content/patient-health/.